Enomoto Tatsuji, Kawamoto Masashi, Kunugi Shinobu, Hiramatsu Kumiko, Sakakibara Keitaro, Usuki Jiro, Azuma Arata, Hirai Kyoji, Koizumi Kiyoshi, Fukuda Yuh, Kudoh Shoji
Fourth Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Nihon Kokyuki Gakkai Zasshi. 2002 Oct;40(10):806-11.
Nine patients undergoing video-assisted thoracoscopic surgical (VATS) lung biopsy over a five-year period from 1997 to 2001 with the ultimate diagnosis of usual interstitial pneumonia without underlying connective tissue disease were identified. In two of nine patients, acute exacerbation occurred six days after VATS lung biopsy. We reviewed the clinical records and pathology of all nine cases, and found that the two cases of exacerbation had higher peripheral white blood cell counts and KL-6, lower PaO2, VC and FEV 1, and a longer inhalation of FIO 2 = 1.0 during VATS, and needed a longer period of chest drainage after VATS. Abundant inflammatory cell infiltration and fibroblastic foci were observed in the exacerbation cases. Thus, patients with usual interstitial pneumonia of the idiopathic type, who have high disease activity and low pulmonary function, may be at high risk of acute exacerbation following VATS lung surgery.
在1997年至2001年的五年间，我们确定了9例接受电视辅助胸腔镜手术（VATS）肺活检的患者，最终诊断为无潜在结缔组织病的普通间质性肺炎。在这9例患者中，有2例在VATS肺活检后6天发生急性加重。我们回顾了所有9例患者的临床记录和病理情况，发现这2例加重患者的外周血白细胞计数和KL-6水平较高，动脉血氧分压（PaO2）、肺活量（VC）和第一秒用力呼气容积（FEV1）较低，在VATS手术期间吸入100%氧气（FIO2 = 1.0）的时间较长，并且VATS术后需要更长时间的胸腔引流。在加重病例中观察到大量炎性细胞浸润和成纤维细胞灶。因此，具有高疾病活动度和低肺功能的特发性普通间质性肺炎患者，在VATS肺手术后可能有急性加重的高风险。
